All information must be provided to process this form. / For Office Use Only
Transaction # ______
ZN Permit # ______
Applicant / Date
Phone / Cell
Current Address
City / State / Zip Code
Family Child Care Facility Information
Business Name
Phone / Fax / Email
Address
City / State / Zip Code
Signature
Occupancy Information and Hours of Operation
Number of residents in the home involved in the business ______Preschool Age #:______School Ages #: ______
Applicants must provide a sketch plan illustrating off-street parking, playground area, principal structure, accessory buildings, and other site information. (Playground area must be 15 feet away from any other residential homes)
Per code section 10-2083.1(c)(2), is the dwelling address visible from the public right-of-way? Yes ____ No ____
Required Information
A plot plan illustrating the required off-street parking, playground area, principal structure, accessory buildings, and other site information must be provided. No signs are allowed advertising the facility in yard or on dwelling.
I have answered the above questions to be best of my knowledge and the proposed Day Care Home will be incidental to the use of my home.
______
Signature Date
Office Use Only
Zoning District / Application: Approved ____ Denied ____
Day Care, Home: No more than eight persons shall be cared for at any given time. Property is zoned for R-1, R-2, R-4, R-6, or R-10. Y____ N____
Comments: / City Official’s Stamp:
Page 2 of 2 www.raleighnc.gov revision 03.23.16